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Summary

Mission and Vision

AHRQ promotes health care quality improvement by conducting and supporting health services research that develops and presents scientific evidence regarding all aspects of health care. Health services research addresses issues of "organization, delivery, financing, utilization, patient and provider behavior, quality, outcomes, effectiveness and cost. It evaluates both clinical services and the system in which these services are provided. It provides information about the cost of care, as well as its effectiveness, outcomes, efficiency, and quality. It includes studies of the structure, process, and effects of health services for individuals and populations. It addresses both basic and applied research questions, including fundamental aspects of both individual and system behavior and the application of interventions in practice settings."1

The vision of the Agency is to foster health care research that helps the American health care system provide access to high quality, cost-effective services; to be accountable and responsive to consumers and purchasers; and, to improve health status and quality of life. An essential part of this vision is assuring that research findings are ready to use by health care decisionmakers: policymakers; private sector leaders; providers; clinicians; and patients/consumers.

The Agency's mission is to:

Improve the outcomes and quality of health care services.

Reduce its costs.

Improve patient safety.

Broaden access to effective services.

AHRQ fulfills its mission through establishing a broad base of scientific research and promoting improvements in clinical and health system practices, including the prevention of diseases and other health conditions.

Strategic Plan

The strategic plan serves as the road map for AHRQ activities. AHRQ has identified four strategic goals, each of which will contribute to improving the quality of health care for all Americans.

AHRQ Goal 1. Safety/Quality. Improve health care safety and quality for all Americans through evidence-based research and translation and to build capacity to improve the quality of health care for Americans.

AHRQ intends to change our budget activity structure to mirror our new strategic plan goals. It is expected that this change will better elucidate AHRQ's research goals and accomplishments. This change will be piloted in FY 2004. In continuing AHRQ's commitment to budget and performance integration, AHRQ recently reorganized the management structure. This new structure aligns those who are responsible for budget formulation, execution, and providing services and guidance in all aspects of financial management with those who are responsible for planning, performance measurement, and evaluation. These functions are now within one office: Office of Planning, Accountability, Resources, and Technology.

Accomplishments by Portfolio of Work

Over time, AHQR plans to provide detailed information about each strategic plan goal by a standard portfolio of work. Based on an analysis of current investments, Department priorities and our mission as articulated by the Congress in authorizing legislation, AHRQ has developed 11 standard portfolios of work. They include:

Bioterrorism.

Data development.

Chronic care management.

Socio-economics of health care.

Informatics.

Long-term care.

Pharmaceutical outcomes.

Prevention.

Training.

Quality/safety of patient care.

Organizational support.

The FY 2005 request is AHRQ's first submission using the new strategic goal areas and the portfolios of work. At this point in time, AHRQ can only provide detailed reporting by one overarching portfolio of work. As the year progresses, AHRQ will move toward providing this information for each strategic plan goal and making transparent how each supports the overarching mission of improving health care quality. Table 1 highlights how AHRQ's portfolios of work are linked to our strategic plan.

Overview of the Performance Plan and Performance Report

The AHRQ Performance Plan is a companion piece to the AHRQ Strategic Plan and to the FY 2005 Budget Request. In this document, the initial FY 2005 and revised FY 2004 Performance Plans have been merged with the FY 2003 Performance Report to comply with the format developed by the Department of Health and Human Services (HHS).

The 2005 Performance Plan focuses on addressing the Agency's vision, mission and strategic goal areas of safety, effectiveness, efficiency and organizational excellence. Within those goal areas, the agency aligns its 11 portfolios of work—activities grouped by categories that reflect agency investments.

Program Assessment Rating Tool (PART) Assessments

Program performance assessments developed using the program assessment rating tool (PART) are an integral component of the President's budget. Table 2 is a progress update on AHRQ's efforts to complete recommendations coming for OMB's PART review of the Data Collection and TRIP programs. AHRQ had no recommendations coming from the FY 2004 PART reviews of the Data Collection and TRIP programs.

Table 2. Data Collection and Dissemination/Translating Research Into Practice (TRIP)

Recommendation

Completion Date

On Track? (Y/N)

Comments on Status

No Recommendations

N/A

N/A

N/A

FY 2004—Data Collection and Dissemination

AHRQ collects data on the cost (Medical Expenditure Panel Survey), use (Healthcare Cost and Utilization Project), and the quality of health care in the United States and develops and surveys beneficiaries regarding their health care plans (Consumer Assessment of Health Plans). In the FY 2005 request, AHRQ continues the $5,000,000 provided in the FY 2004 enacted level to support efforts to ensure continued collection and availability of national health care cost, use, and quality data. These funds will be directed to performance-based improvements for the three data collection and dissemination programs.

FY 2004—Translating Research into Practice

In FY 2005, AHRQ is requesting $10,400,000, an increase of $3,400,000 from the FY 2004 Enacted, for studies focused on translating research into practice (TRIP). The increase in funds is attributable to AHRQ's new grant and contract program: Research Empowering America's Changing Healthcare System (REACHES). These grants and contracts will expand work in the area of adopting research findings in real-world settings, assessing their impact and generalizability, and promoting rapid uptake of successful efforts.

This program refocuses TRIP activities to include activities other than just research grants. This places greater emphasis on translation, dissemination, and implementation in a broader sense. AHRQ's revision of the strategic plan/goals and its organizational realignment was specifically designed to assure successful implementation of evidence-based findings.

Research Coordination Council

AHRQ staff fully participated in the Research Coordination Council (RCC) work groups, which reviewed the FY 2005 research budget requests submitted by the agencies and assisted in the development of findings and recommendations for consideration by the Secretary's Budget Council. The purpose of these work groups is to identify ways to increase the efficient use of existing resources by identifying opportunities to collaborate with other Agencies. The following are some examples of how AHRQ contributed to the RCC:

Potential for overlapping areas of focus or gaps in research efforts.

Efforts include the Health Care Information Technology (HIT) program which covers improvements in the Indian Health Service's electronic health record and joint programming with Centers for Medicare and Medicaid Services (CMS).

Fostered increased collaboration and coordination with other HHS Agencies.

AHRQ, Food and Drug Administration (FDA), the Center for Disease Control (CDC), and CMS will jointly develop a National Patient Safety Network.

RD&E program improvements or efficiencies related to the FY 2005 planning process.

AHRQ, the Office of the Assistant Secretary for Planning and Evaluation (OASPE), the Centers for Medicare & Medicaid Services (CMS), the National Center for Health Statistics (NCHS), and the National Institute on Aging (NIA) are working to improve the Department's long-term care data systems.

AHRQ, the Centers for Disease Control and Prevention (CDC), the Health Resources and Services Administration (HRSA), the Indian Health Service (HIS), and the Administration on Aging (AOA) will work collaboratively to implement the prevention funding CDC received.

AHRQ has a long history of developing partnerships and collaborations with a variety of HHS organizations, other components of the Federal Government, State and local governments and private-sector organizations, all of whom help us to achieve our goals.

AHRQ will continue to work with the RCC it begins to implement the FY 2005 budget. In addition, AHRQ will strengthen and build upon these partnerships as it moves to implement its FY 2006 budget request. Table 3 summarizes AHRQ's FY 2005 Research, Demonstration and Evaluation (RD&E) activities. These activities align with the Secretary's and President's priority areas and were included in our RCC discussions.

Summary of FY 2005 Request

The FY 2005 budget for AHRQ totals of $303,695,000, maintaining the FY 2004 enacted level. This request allows AHRQ to support ongoing efforts to improve the quality, safety, outcomes, access to and cost and utilization of health care services.

The FY 2005 budget enables AHRQ to renew several grant programs that help support the health care quality infrastructure. These include Building Research Infrastructure & Capacity Program (BRIC), Minority Research Infrastructure Support Program (M-RISP), Centers for Education and Research on Therapeutics (CERTs) program, and Practice-Based Research Networks (PBRNs).

AHRQ requests $1,000,000 for the BRIC program, which is intended to build the research capacity in States that have not traditionally been involved in health services research. Ten States received direct funding from this program in FY 2001. For example, in Mississippi where health care for children living in the Delta region is poor or nonexistent, a BRIC grantee has formed partnerships with several pediatric experts, including consultants from Harvard. These partnerships are essential to the Department's efforts to improve care for residents of this region.

AHRQ requests $3,400,000 to support four CERTs grants. The program is administered as a cooperative agreement by AHRQ in consultation with the Food and Drug Administration (FDA) to promote the safe and effective use of therapeutics. The Centers have completed several important projects since their inception. For example, researchers at the University of North Carolina Center found a link between rickets in breast-fed children and a lack of vitamin D supplementation, especially among black infants. As a result of this study, the North Carolina Department of Health made vitamin "D" available free to breast-feeding women though its Women, Infants, and Children (WIC) program.

AHRQ requests $2,000,000 for core support of the work of primary care practice-based research networks (PBRNs). PBRNs are groups of community-based practices that work with clinical investigators to study questions related to primary care and to assure that evidence-based findings are incorporated into actual practice. With current levels of funding, AHRQ has been able to support 40 networks nationwide. These networks include around 10,000 primary care providers (pediatricians, family physicians, general internists, and nurse practitioners) in community-based practices located in rural, suburban and inner-city settings in all 50 States. These clinicians provide care to around 10 million Americans.

AHRQ requests $1,000,000 to fund three additional M-RISP grants. The program was established to increase the capacity of institutions that serve racial and ethnic minorities to conduct rigorous health services research. The research conducted by these institutions focuses on the Departmental priorities of reducing racial and ethnic disparities and improving health for priority populations.

The request also provides $6,639,000 for continued support of the following research grant programs:

Small research grants.

Conference research grants.

Dissertation research grants.

Grant supplements.

The research career program.

In addition, AHRQ will fund $2,414,000 in new non-patient safety grants and $3,947,000 in new non-patient safety contracts for Research Empowering America's Changing Healthcare System (REACHES). These grants and contracts will expand work in the area of adopting research findings in real-world settings, assessing their impact and generalizability, and promoting rapid uptake of successful efforts.

In FY 2005, AHRQ will continue its work in area of patient safety. Unfortunately, fatalities due to medical errors continue to occur in our heath care system. In early 2003, organ transplant patient Jessica Santillan died at Duke University Hospital after receiving a second heart and lung transplant when her body rejected the first transplant because those organs were not matched to her blood type. This tragedy is not attributable to a knowledge deficit, but demonstrates how critical it is that we continue to focus on the role that the system plays in patient care. AHRQ has found through its research that by creating a safe and effective system of care we can significantly reduce the number of errors that occur. AHRQ's patient safety program is aimed at identifying risks and hazards that lead to medical errors and finding ways to prevent patient injury associated with delivery of health care.

The FY 2005 request of $84,000,000, an increase of $4,500,000 from the FY 2004 enacted level, enables AHRQ to continue to support research activities that help health care providers, hospital and health care system leaders, and policymakers address the many challenges that they face and provides the foundation for which they can produce measurable quality improvements in health care.

Secretarial Priorities

At the requested level, AHRQ's programs will make important contributions to the Secretarial Priorities and Presidential Initiatives on improving the quality and safety of health care, costs, use and access to health care. AHRQ has worked closely with the Department's Research Coordination Council, Data Council and the Assistant Secretary for Planning and Evaluation (ASPE) so that investments in FY 2005 can be leveraged with the investments of other Operating Divisions (OPDIVs) to achieve maximum impact.

In addition, the Director of AHRQ co-chairs the Secretary's Council on Applications of Health Information Technology to promote synergy across HHS investments in health information technology, i.e., to identify and implement initiatives that address multiple department objectives, such as improving quality and safety, identifying adverse events and potential warnings of bioterrorist attacks, and conducting research.

FY 2005 Budget Policy

The FY 2005 request of $303,695,000 maintains the FY 2004 enacted level. This request allows AHRQ to support ongoing efforts to improve the quality, safety, outcomes, access to and cost and utilization of health care services. Specifically, this increase will:

Mechanism Discussion

Research and Training Grants

The FY 2005 request provides a decrease of $14,855,000 for research and training grants over the FY 2004 enacted level of $113,770,000.

An increase of $13,539,000 is requested to renew the following non-patient safety research programs: small grants, conference grants, dissertation grants, Centers for Education and Research on Therapeutics (CERTs), Building Research Infrastructure and Capacity Program (BRIC), the Minority Research Infrastructure Support Program, and Primary Care Practice-based Research Networks (PBRNs). An increase of $500,000 is requested for grant supplements, for a total increase of $14,039,000 for renewed grant programs. The FY 2005 request also provides $2,414,000 in new grant support for Research Empowering America's Changing Healthcare System (REACHES). These grants will expand work in the area of adopting research findings in real-world settings and assessing their impact and generalizability.

AHRQ is also requesting that the $7,000,000 in planning grants for the Health Care Information Technology program (patient safety) that ended in FY 2004 be reinvested in FY 2005. In FY 2005, these funds will be used for implementation awards for communities that have completed a successful planning process in FY 2004.

Non-MEPS Research Contracts and Interagency Agreements (IAAs)

The FY 2005 request provides an increase of $12,955,000 for research contracts and IAAs from the FY 2004 enacted level of $82,625,000.

The FY 2005 request for patient safety contracts and IAAs increases by $5,488,000 from the FY 2004 enacted level of $25,740,000. A total of $1,800,000 of this increase is for a new IAA to the Indian Health Service (IHS) for ambulatory information technology demonstrations.

The FY 2005 request for non-patient safety contracts and IAAs is increased by $7,507,000 from the FY 2004 enacted level of $51,564,000. A total of $3,560,000 will be directed to enduring research contracts. In addition, AHRQ requests $3,947,000 for new contracts focusing on Research Empowering America's Changing Healthcare System (REACHES). These contracts will be designed to further the adoption of research findings into real-world practice and assessment of their impact in our main portfolio areas.

Medical Expenditure Panel Survey (MEPS)

Research Management

In FY 2005, AHRQ requests an increase of $1,900,000 for research management costs. These funds will provide for current services, including amortization of the FY 2004 pay raise and the FY 2005 pay raise.

The Unified Financial Management System (UFMS) is being implemented to replace five legacy accounting systems currently used across the Operating Divisions. The UFMS will integrate the Department's financial management structure and provide HHS leaders with a more timely and coordinated view of critical financial management information. The system will also facilitate shared services among the OPDIVs and thereby, help management reduce substantially the cost of providing accounting services throughout HHS. Similarly, UFMS, by generating timely, reliable, and consistent financial information, will enable the component agencies and program administrators to make more timely and informed decisions regarding their operations. AHRQ requests $907,000 to support this effort in FY 2005.

AHRQ's FY 2005 request includes funding to support the President's Management Agenda E-Gov priorities and Departmental enterprise information technology priorities identified through the HHS strategic planning process. Agency funds will be combined with resources in the Information Technology Security and Innovation Fund to promote collaboration in planning and project management and to achieve common goals such as secure and reliable communication and lower costs for the purchase and maintenance of hardware and software. The enterprise IT investments enable HHS programs to carry-out their missions more securely and at a lower cost. Examples of HHS enterprise projects currently being funded are Enterprise E-mail, Network Modernization, and Public Key Infrastructure.

Budget Activities

Health Care Costs, Quality, and Outcomes (HCQO)

The purpose of the Research on Health Care Costs, Quality and Outcomes activity is to support and conduct research that improves the outcomes, quality, cost, use and accessibility of health care. Accordingly, the Agency has identified three strategic plan goals that feed into this budget activity:

The key themes throughout all three goals are to fund new research and to translate research into practice. In addition, AHRQ also has strengthened its commitment to support research that will improve health care for vulnerable populations. Lastly, AHRQ has enhanced specific activities that support all of our strategic goals.

Medical Expenditure Panel Survey (MEPS)

Obtain timely national estimates of health care use and expenditures, private and public health insurance coverage, and the availability, costs and scope of private health insurance benefits among the U.S. population.

Analyze changes in behavior as a result of market forces or policy changes (and the interaction of both) on health care use, expenditures, and insurance coverage.

Obtain information on access to medical care, quality and satisfaction for the US population and for those with specific conditions, and for important subpopulations.

Develop cost and savings estimates of proposed changes in policy.

Identify the impact of changes in policy for key subgroups of the population (i.e., who benefits and who pays more).

These objectives are accomplished through the fielding of the Medical Expenditure Panel Survey. MEPS is an interrelated series of surveys that replaces the National Medical Expenditure Survey (NMES). MEPS not only updates information that was last collected more than a decade ago in FY 1987, but also provides more timely data, at a lower cost per year of data, through the move to an ongoing data collection effort.

Program Support

Program Support provides support for the overall direction and management of the AHRQ. This includes the formulation of policies and program objectives; and administrative management and services activities.